Not Applicable
Not Applicable
1. Field of the Invention
This invention relates to cardio myopathy and the treatment thereof.
2. Description of the Prior Art
By way of background, cardio myopathy, as caused for example by myocardial infarction, is a common disorder. Twenty thousand new cases are reported yearly in the United States and 25-50% of such cases will result in death after three years. The problem is that damaged adult heart muscle does not regenerate and myocardial functionality cannot be restored using the body""s natural healing mechanisms. The myocardium tends to dilate and areas of the ventricular walls may become hypokinetic, or even akinetic, such that congestive heart failure often develops in affected individuals.
Previous medical techniques have not substantially reduced the morbidity or mortality of this condition. Staged latissimus dorsi cardiomyoplasty is one mode of treatment. According to this method, latissimus dorsi muscle is pulled into the left pleural cavity and sutured to the damaged area. A disadvantage of this treatment is that eight weeks of muscle conditioning is required before the latissimus dorsi muscle is ready for attachment to the myocardium, and at least two operations are needed. A further proposal has also been made for an alternative treatment that involves the implantation of skeletal myoblasts, fetal cardiocytes or transformed embryonic stem cells into an infarcted myocardium. Laboratory research suggests that the implanted cells tend to fuse with surrounding muscle fibers to regenerate functional muscle that improves myocardial performance. This treatment, however, has not been clinically validated and it may be questioned whether the treatment can be effective without a mechanism for promoting new vascularization in and around the cell growth area.
More recently, one of the inventors herein patented a novel cardio myoplasty method involving use of an existing blood supplier, such as a patient""s greater omentum, to provide support for, and deliver blood to, transplanted autogenous muscle grafts on an area of damaged tissue, such as the myocardium. See U.S. Pat. No. 5,327,913. This patent also discloses a novel instrument for retrieving muscle grafts from autogenous skeletal muscle tissue. What the patent does not disclose, however, is a system or method for attaching muscle grafts in place prior to applying the blood supplier. Accordingly, a need exists for an improved cardio myoplasty method and a related system providing a mechanism for muscle graft attachment.
The foregoing problems are solved and an advance in the art is obtained by an improved method of autogenous cell patch cardio myoplasty. Preferably using noninvasive thoracoscopy, autogenous muscle grafts are secured and then supported by the greater omentum to reinforce the dilated myocardium and correct diskinetic myocardium malfunction. In accordance with preferred embodiments of the invention, a patient""s greater omentum is separated at or near its point of attachment to either the greater curvature of the stomach or the transverse colon. All open blood vessels in the greater omentum are ligated to permanently arrest bleeding. A free end of the greater omentum is then introduced into the left pleural cavity through an opening made in the diaphragm. Muscle grafts are removed from autogenous skeletal muscle tissue and an opening is formed in the pericardium to expose a damaged area of the myocardium. Following attachment of the skeletal muscle grafts to either the greater omentum or the damaged myocardium area, which is preferably performed using an advanced muscle graft implantation system, the greater omentum is wrapped around the heart and secured thereto in order to reinforce the muscle grafts and enrich them with blood flow.